Maiden Genevieve, Kingsford Annabel, Wang Audrey P, Tran-Nam Anh R, Nelson Julia
Uniting War Memorial Hospital, Waverley, Australia.
Biomedical Informatics and Digital Health, School of Medical Sciences, University of Sydney, Australia.
Int J Integr Care. 2024 Sep 17;24(3):21. doi: 10.5334/ijic.8066. eCollection 2024 Jul-Sep.
integrated Rehabilitation and EnAblement Program (iREAP) is an innovative redesign of the traditional day rehabilitation model, providing an anticipatory, early assessment and intervention program that manages care of community-dwelling older people with complex needs. It coordinates access to disciplines across medical, allied health and nursing, with a self-management focus, partnering with primary health in an integrated approach.
This observational study reviews the effectiveness of iREAP on frailty, patient activation, quality of life and physical outcome measures on older people at risk of, or experiencing falls and frailty, or with neurodegenerative conditions, including Parkinson's Disease.
99 participants completed the eight-week multidisciplinary program. Patient outcome measures included Rockwood Clinical Frailty Scale, quality of life measures, Patient Activation Measure, Timed Up and Go, 6 Minute Walk Test and Berg Balance Scale.
On completion of iREAP, participants displayed improvements in their Rockwood Clinical Frailty Scores (mildly frail to vulnerable), 'patient activation' (55.08 to 60.61), quality of life (Parkinson's Disease Questionnaire-39, 49.93 to 47.16; WHO Quality of Life - Bref physical domain, 21 to 22.7) and physical measures including balance (44 to 49/56 Berg Balance scale) and mobility (294 m to 336 m, 6-minute walk test). Falls were not reduced at twelve months post-program (3.40 to 2.01).
iREAP is an interdisciplinary, early assessment and intervention program with the potential to reverse frailty and improve quality of life for complex older patients. This paper offers a platform for future research, given the paucity of evidence reviewing the efficacy of integrated anticipatory models of care in older adults with complex needs.
综合康复与赋能计划（iREAP）是对传统日间康复模式的创新性重新设计，提供一种前瞻性的早期评估和干预计划，用于管理有复杂需求的社区居家老年人的护理。它以自我管理为重点，协调医学、辅助医疗和护理等多学科的服务，以综合方式与初级卫生保健合作。
这项观察性研究评估了iREAP对有跌倒和衰弱风险、正在经历跌倒和衰弱或患有神经退行性疾病（包括帕金森病）的老年人的衰弱、患者自我管理能力、生活质量和身体状况指标的有效性。
99名参与者完成了为期八周的多学科计划。患者结局指标包括罗克伍德临床衰弱量表、生活质量指标、患者自我管理能力量表、计时起立行走测试、6分钟步行测试和伯格平衡量表。
完成iREAP后，参与者的罗克伍德临床衰弱评分（从轻度衰弱到脆弱）、“患者自我管理能力”（从55.08提高到60.61）、生活质量（帕金森病问卷-39，从49.93降至47.16；世界卫生组织生活质量简表身体领域，从21提高到22.7）以及包括平衡能力（伯格平衡量表从44分提高到49/56分）和活动能力（6分钟步行测试从294米提高到336米）在内的身体指标均有所改善。在计划结束后的12个月，跌倒次数未减少（从3.40次降至2.01次）。
iREAP是一个跨学科的早期评估和干预计划，有可能扭转衰弱状况并改善复杂老年患者的生活质量。鉴于审查针对有复杂需求的老年人的综合前瞻性护理模式疗效的证据较少，本文为未来研究提供了一个平台。
